Graft‐versus‐host disease (GVHD)‐specific survival and duration of systemic immunosuppressive treatment in patients who developed chronic GVHD following allogeneic haematopoietic cell transplantation

Abstract

Summary. We investigated graft-versus-host disease (GVHD)-specific survival (GSS) and the duration of systemic immunosuppressive treatment (IST) in 82 patients who developed chronic GVHD following allogeneic haematopoietic cell transplantation (HCT). These two major study endpoints were calculated using the Kaplan-Meier method. Deaths solely due to the relapse of underlying disease or accidental deaths were censored at the time of occurrence for the analysis of GSS. The probability of GSS at 5 years was 74AE2%. The median duration of systemic IST for chronic GVHD was 272 d (range: 7-1450), and the probability of withdrawal of systemic IST at 1, 2 and 3 years was 67AE3%, 82AE4% and 89AE0% respectively. Analysis based on a multivariate model showed that a diagnosis other than leukaemia or myelodysplastic syndrome (P ¼ 0AE049), prior occurrence of grade III-IV acute GVHD (P ¼ 0AE021), onset of chronic GVHD before d 120 (P ¼ 0AE013), serum alkaline phosphatase over 120 IU/l (P ¼ 0AE034), and serum bilirubin over 34AE2 lmol/l (P ¼ 0AE015) were independent adverse prognostic factors for GSS. Prior occurrence of grade III-IV acute GVHD significantly influenced the duration of systemic IST (P ¼ 0AE048). In conclusion, analyses of GSS and the duration of systemic IST will allow patients with different outcomes to be stratified for appropriate treatment application and will provide important parameters in prospective trials for the treatment of chronic GVHD.

Risk and prognostic factors for Japanese patients with chronic graft-versus-host disease after bone marrow transplantation

“…22 The presence of cGVHD did not show prognostic significance for our patients, which might be the result of the neutralization of the positive and negative effects of cGVHD on survival. The result of our analyses limited to those with clinical extensive cGVHD indicate that it is not due to the higher proportion of patients with limited cGVHD in Japanese patients which contribute to the different outcomes from the Westerns.…”

“…A forward stepwise method was applied for detecting sets of independent significant factors. In the previously reported studies of prognostic factor analyses of cGVHD, the statistical end point was either cGVHDspecific survival, 10,15,22 or overall survival. 11 Our analyses were therefore also performed with overall survival as the statistical end point.…”

“…Although the term 'cGVHD-specific survival' does not completely exclude all deaths without recurrent malignancy, we used this term in its traditional meaning of recurrence censored survival. 10,15,22 Death because of relapse of underlying hematological disorders was censored at the time of relapse. Cox regression model was used to analyze data for the identification of prognostic factors.…”

Risk-factor analysis for predicting progressive- or quiescent-type chronic graft-versus-host disease in a patient cohort with a history of acute graft-versus-host disease after allogeneic stem cell transplantation

“…The GSS of the current cohort was estimated as 55.9%, which seemed to be relatively lower than that in another study. 4 However, the explanation for this was the poor prognostic characteristics of the present cohort with regard to cGVHD.…”

“…Previous investigations have always included de novo cGVHD in their analyses to identify the risk factors for cGVHD in a cohort of patients with or without aGVHD. 4,5 Yet, it may be more reasonable to predict the risk of pq cGVHD in a patient group who experienced aGVHD, while predicting the risk of de novo cGVHD in a patient group without aGVHD. Clinically, it is important to focus specifically on pq cGVHD, rather than overall heterogeneous cGVHD, in order to set up an appropriate plan to minimize the risk of pq cGVHD progressing from aGVHD.…”